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NPI Code Detail

MEDICARE: KATHRYN MANDELBAUM JOHNSON PA-C

MEDICARE: KATHRYN MANDELBAUM JOHNSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant3470CO

General Provider Information

NPI Number : 1205911328
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN MANDELBAUM JOHNSON PA-C
Provider Business Mailing Address
First Line : 345 MAXWELL AVE
Second Line :
City : BOULDER
State : CO
Zip : 80304-3972
Country : US
Telephone Number : 303-544-5783
Fax Number : 303-441-2388
Provider Business Practice Location Address
First Line : 2575 SPRUCE ST
Second Line :
City : BOULDER
State : CO
Zip : 80302-3806
Country : US
Telephone Number : 303-449-3594
Fax Number : 303-449-3112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 10/08/2012

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Directions to “ KATHRYN MANDELBAUM JOHNSON PA-C” Practice Location

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